More important than Obamacare mandate

This week the Supreme Court did what it is supposed to do by making sure all our laws reflect the meaning of the Constitution. Like most Americans, I spent the week listening to clips of the arguments, judging the judges on their questions and being generally dismayed at the political tone of the arguments. One of the hosts I report for, Steve Bowers, reminded me of Pat Buchanan’s words that the justices are “politicians in black robes.” Although I can’t find the quote, the idea is clear, these nine justices are acting from their political perch and not a perch that is going to change medicine in the country.

People are freaking out about the individual mandate. Arguments are raging about how much this is going to save our country by providing preventive health care and allowing savings to come from better planning and delivery. Both sides are claiming they have the correct answer about saving us billions or putting the deficit in the hole by billions and perhaps trillions.
The real issue is cost. Is it really a family visit to the local doctor that is costing the money? Is it really the breast exam that is going to break our collective bank, or is it something else? Do birth-control pills really run up the tally so much that it is worth a cultural war?

I have learned from my friend and colleague, Jim Pinkerton, that this war over health care is misguided. He believes that what is really going to change our costs for medical care is what he calls “serious medicine.” It is estimated that heart disease treatment cost $172 billion in 2010, and will cost up to $276 billion in 2030. The American Cancer Society estimated that in 2007 the total cost (including lost productivity) was $226.8 billion per year. Just those two diseases alone cost a good chunk of our health-care price tag. Add the direct costs of Alzheimer’s disease of $172 billion (not including lost productivity of the person or the caregiver), and you have serious costs to our economy. I have a friend, Gregory Oxenkrug, research professor of psychiatry at Tufts University School of Medicine, who thinks that a considerable amount of mental illness is due to inflammation. He has to scramble to get even a few thousand dollars to do his research. If he is right, he could save us billions in mental health-care costs, let alone make a lot of people more productive.

What does Jim Pinkerton recommend to save us these billions? Over the course of dinner, Jim explained to me what needs to be done. “We need cures,” he said. “Look at the March of Dimes. We cured polio, and it costs us almost nothing now.” Because Jim is a conservative, he told me, “People who live longer pay more taxes.” He knew I would love his reasoning!

He has written about his ideas on his “Serious Medicine” blog. He said, “We are seeing an astonishing fall-off in what might be called serious medicine – that is, the sort of medicines that can make a decisive positive impact on the course of a disease. So a Serious Medicine Strategy is the concentrated and determined search for medical cures. Serious Medicine Strategy is a way of leveraging national and international assets into a plan for reviving medical innovation and, just as importantly, medical production. We don’t need a federal tax increase, or a federal spending increase. We simply need to turn America into the R&D-friendly equivalent of an enterprise zone.”

Jim quotes from the Food and Drug Administration. He said, “Approvals of new drugs (new molecular entities and biologics) have shown an even steeper falloff, 63 percent. The number of new antibiotics is down by 81 percent over the last quarter-century. Meanwhile, the pharma and biotech companies are laying off researchers, and even shutting down whole divisions.

“It’s been estimated that the number of medical venture capitalists in the U.S. is shrinking by as much as three-fourths.

“So instead of these fights over health insurance and the costs of it,” Jim writes, “as a national endeavor, a Serious Medicine Strategy is a win-win-win-win. A win, that is, for health and wellness, a win for job creation and growth within the health-care sector, and a win for technological spinoffs that benefit the rest of the economy, and a win for the overall American economy. ”

Jim sums it up: “A cure is cheaper than care.”

I couldn’t have said it better. Too bad we got caught up in the insurance debate and not the real issues: cures and serious medicine.